Provider Demographics
NPI:1689643025
Name:IYER, RADHA R (MD)
Entity type:Individual
Prefix:DR
First Name:RADHA
Middle Name:R
Last Name:IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:PO BOX 648
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8648
Mailing Address - Country:US
Mailing Address - Phone:585-487-3319
Mailing Address - Fax:585-273-1033
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8648
Practice Address - Country:US
Practice Address - Phone:585-487-3319
Practice Address - Fax:585-273-1033
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1430472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6348Medicare PIN
B79870Medicare UPIN